Article

Compliance

Your role in acquisitions

How to ensure your practice is compliant prior to a sale or merger.

At some point, your physician-owner may consider selling or merging his or her practice or acquiring a new practice. These decisions involve operational and financial components that need to be considered. If you are a part of the management team, you may be asked to help prepare for such decisions by reviewing internal processes, visiting a practice being considered for mutual alignment, or completing a related assessment. Knowing this, it may be helpful to look at the existing processes that influence your practice on a day-to-day basis.

Before a practice undergoes any major changes, all processes must be efficient and compliant. The following list outlines 10 practice operations that administrators can help evaluate before the sale, merger, or acquisition of a practice.

1. Financial review.

If there is a monthly benchmarking program in place, take the time to carefully review and compare it to industry standards for ophthalmology practices. Note any significant variances that fall outside of the recommended ranges.

Once your review is complete, explore all significant variations to determine their cause, adjusting processes as necessary.

Finally, review any debt on the books and develop a timely plan to address it.

2. Written policies and procedures.

Most well-run practices have written personnel policies that cover PTO, benefits, and more. Similarly, every practice should have written policies and procedures for each area of the practice. For example, the billing department’s written procedures should include the proper way to submit a claim and how to handle a denied claim. If no such policies are in place, the manager of each area/department should write them.

3. Compliance plan.

Every well-managed, responsible practice should have an up-to-date compliance plan to ensure federal laws are followed at all times. Unlike the department-specific policies above, the compliance plan should serve as an overarching set of guidelines for the entire practice, including processes for documenting activities.

4. Standards of conduct.

These standards should be created with input by the physician-owner(s). Having and adhering to well-written conduct guidelines reflects a commitment to follow ethical and legal stipulations at all times. Additionally, any employee who is non-compliant with either the compliance plan or standards of conduct should face serious consequences.

5. Fraud, waste, and abuse training.

All health-care employees must recognize and understand a situation that may involve fraud, waste, or abuse of resources. New employees must be educated on how to recognize and report any activity that may involve fraud, waste or abuse of any federally funded health-care program. Employees should re-train each year, as annual training is required by federal law.

6. OSHA training.

Employees at risk of exposure to blood-borne pathogens must receive OSHA training within 10 days of being hired or being reassigned to a job that has risk of exposure. Additionally, annual re-training on OSHA’s Bloodborne Pathogens Standard and the Hazardous Communication Standard is required by law.

7. HIPAA training.

Staff must be trained on how to protect patient information, whether written or electronic. For this reason, HIPAA training is required upon an employee’s hiring, and re-training is required annually. Such training ensures that all staff know how to respond to and report any issues.

8. Disaster planning.

While not regulated by law, it is vital that ophthalmic staff know how to respond to an emergency. Whether facing a natural disaster, a chemical spill, or an active shooter, a prudent practice will have a plan in place. Fire drills — which should involve practice using a fire extinguisher and moving patients — can save lives should an actual disaster occur. Any disaster planning should revolve around the most likely events to take place in your area.

9. Risk assessment.

Risk analysis should be performed on the information systems in the practice at least every two years — more often if there is a concern. This is necessary to ensure patient data is secure and the electronic security measures remain strong. When performing such analyses, it is advisable to contract an outside party.

10. Internal and external audits.

Internal audits of medical records should be done at least quarterly and an external audit (completed by an independent group invited in or contracted by the practice) should be done at least every two years. To ensure a thorough, accurate audit, the internal audit committee must have the appropriate amount of time allocated for completion.

Conclusion

These 10 tips do not represent an all-inclusive list. But, if all these processes are in place and actively implemented, your practice is off to a great start. If the physician-owners are considering selling the practice, an external review of these components may provide further guidance and knowledge.

As practice employees, it is helpful for you to provide feedback on any of the areas above to assist your manager with identifying potential areas for improvement. Employees should be confident in their ability to locate information on areas listed in this article. Manuals for compliance may be online or in a binder, but every staff member should know how to access information on the training areas listed in this article.

Additionally, performing a thorough review of all the above components will ensure that any practice planning on acquiring or merging with another group has well-aligned core values and visions. OP